Agenda item

Report of the Director of Care, Health and Housing

The Board received a report of the Director of Adult Care, Health and Housing regarding the Better Care Fund – 2023/25 review and 2025/26 planning approval.

The Better Care Fund (BCF) commenced in 2015 with an aim of bringing together the NHS, social care and housing services, so that older people and those with complex needs could manage their own health and wellbeing and live independently in their communities for as long as possible.

It was based on the concept of a pooled budget between Integrated Care Boards and Local Authorities with one party agreeing to ‘host’ the pool which was managed by a s75 legal agreement.  The Coventry BCF pool was hosted by Coventry City Council and overseen by the Coventry Care Collaborative.

The pooled fund associated with the 2023/25 plan totalled approximately £148m, which delivered against 104 separate lines of expenditure across Health and Social Care. Areas of expenditure included social care, learning disability support, dementia, carers, disabled facilities grant and support to enable effective hospital discharge.

The agreed priorities to support the 2 BCF objectives to 1) enable people to stay well, safe, and independent at home for longer and 2) provide the right care in the right place at the right time, were as below along with a summary of progress over the plan period:

Priority One:  further implementation and take up of the Integrated Care Record in Social Care – will improve information sharing and access to records held in health and social care and ultimately enhance patient/resident experience.

Priority Two: improvement on Disabled Facilities Grant (DFG) processing and activity to improve ability to support people at home through adaptions, including those to temporary accommodation.

Priority Three:  further development and implementation of the ‘Improving Lives for Older People’ programme focussed on a whole pathway improvement from admission avoidance through to discharge.  A core objective of this programme was to provide health care and support to people at home and prevent issues of ‘flow’ through reducing the need for people to transfer to hospital in the first place through greater integrated working and approaches.

Delivery against the metrics at the end of 2024/25 was as follows:

-  Rate of avoidable admissions per 100k population – target met

-  Emergency hospital admissions due to falls in people aged 65 and over per 100k population – target met

-  Percentage of people, resident in the HWBB area, who were discharged from acute hospital to their normal place of residence – target met

-  Long term support needs of older people (aged 65 and over) met by permanent admission to residential and nursing care homes, per 100k population (65+) – target met

Summary of the 2025/26 BCF Plan

The Better Care Fund Plan for 2025/16 required submission to NHSE by 28^th March 2025.  As there was not an available Health and Wellbeing Board meeting to correspond with this timescale, this update on the 2025/26 plan is retrospective.

Once submitted, the BCF plan goes through a regional assurance process before confirmation of approval is received.  As at 18 June 2025, no communication had been received from the regional BCF team to confirm approval or otherwise.  As it was a 12 month plan for which 3 months had now elapsed, it was assumed that the plan had been approved.

The key points in relation to changes to the BCF for 2025/26 were:

• The minimum NHS contribution for Coventry was £554,636 (1.53%) which all had to go to minimum contribution to ASC.  This was slightly less than the 1.7% which was partly driven by NHSE setting an ICB discharge fund amount per ICB and the impact of the locally applied Cov & Warks split.
• The additional £554K was mostly consumed by inflation on services funded via BCF.
• The Discharge Fund was no longer ringfenced for discharge but would continue to be used for that purpose (as per 2024/25) until reviewed in the context of other BCF priorities.

Although BCF plans covered distinct periods of time, much of the work did not sit neatly within a 12 or 24 month cycle, so there was a large degree of continuity between plans.  Progress as a set of Health and Care partners did progress and as such, the key changes since the 2024/25 plan were:

• The emerging system governance had now been established.  The Care Collaborative had been established as a sub-committee of the ICB with a Care Collaborative Forum in place to support.  The system responsibility for BCF plan delivery is within these forums.
• The Improving Lives programme had been delivered and was now Business as Usual with a programme of continuous improvement required in order to ensure that benefits were maximised and service models embedded.

For 2025/26, the total value of the BCF fund was £137m which was deployed to deliver 81 separate lines of activity and services. 

The 2025/26 plan contained the following priority actions against the 2 overarching BCF objectives:

• Objective 1 – reform to support the shift from sickness to prevention.
• Objective 2 – reform to support people living independently and the shift from hospital to home.

The BCF plan priorities were:

• The work completed under the previous BCF plan through the Improving Lives programme had a demonstrable impact on preventing avoidable hospital admissions.  This work would be built on and further embedded over this BCF plan.
• Integrating P3 and Fast Track approaches with the D2A discharge capacity in order to ensure people are supported in the most appropriate manner and to achieve more timely and effective discharge from acute and community, including end of life care.
• Reviewing our commissioning capacity to ensure this was appropriately sized and resourced to support demand.  The Improving Lives programme had reduced the numbers of people requiring ongoing residential care following discharge from hospital, so ensuring the changes were embedded and the benefits maximised will form a key part of this plan.

BCF metrics formed a significant part of the quarterly reporting requirements.  For 2025/26, the metrics were as follows:

• Emergency admissions to hospital for people aged 65+ per 100,000 population.
• Average length of discharge delay for all acute adult patients, derived from a combination of: Proportion of adult patients discharged from acute hospitals on their discharge ready date (DRD). For those adult patients not discharged on DRD, average number of days from DRD to discharge.
• Long-term admissions to residential care homes and nursing homes for people aged 65+ per 100,000 population.

For the 2025/26 BCF plan, the Coventry Care Collaborative would be the primary place of oversight for Coventry with reports to the Coventry Health and Wellbeing Board to correspond with quarterly submissions of NHSE.

Changes to the BCF in respect of areas of spend would be kept under review as services develop and demands changed.

The Cabinet Member for Adult Services commented on the discharge fund, advising it was no longer ring-fenced for discharge, but would continue to be used for that purpose.

The Chair, Councillor K Caan, commended the Director of Care, Health and Housing, P Fahy on his focus on unpaid carers and the work they undertake across the city.

RESOLVED that the Health and Wellbeing Board:

1)  Note the review comments regarding the 2024/25 Better Care Programme.

2)  Endorse the 2025/26 Better Care programme submission to NHSE.